Sample withdrawal

Sample withdrawal form

(If you wish to cancel the contract, please fill out this form and send it back to us).

PROOX GmbH

Seglerweg 1

6972 Fussach

I/we (*) hereby revoke the contract concluded by me/us (*) for the purchase of the following goods (*)/the provision of the following service (*):

___________________________________________________________________

Ordered on (*) _____________________________________

received on (*) ____________________________________

Invoice number, if available: ____________________

Invoice amount: __________________________________

Name of the consumer(s) ___________________________________________

Address of the consumer(s) _________________________________________

_________________________________________

Date ____________________

Signature of the consumer(s) (only for notification on paper)

_________________________

(*) Delete as appropriate.